Last updated on January 6th, 2024 at 08:33 am
Diplopia is when one sees a real object in one’s visual field plus a “ghost” image of that object to the right or left of the real object. During one period 12.3% of ambulatory ER visits were for acute or subacute diplopia.
By Les Ruthven, Ph.D. clinical psychology/behavioral health mgmt.
Email: lruthven.mafinearts@gmail.com
Health blog: www.ruthvenassessments.com
A year ago while driving on the highway I realized I had double vision (or binocular diplopia). As traffic approached me from the other direction I saw the automobile approaching me plus a “ghost” image of the same automobile well above ground and almost in my lane. The ghost images occurred when the traffic was straight ahead of me and when the road curved to the right I had a ghost image of the yellow line and the traffic approaching me on the curve of the road. Later at a stop light with an automobile in front of me I turned my head to the right and I had a ghost image of the same car to the right. The same ghost appeared when I turned my head (gaze) to the left of the car in front of me. To remove the ghost image from either the left or the right of my frontal vision I simply shut either eye and the “ghost” disappears, which means I have binocular rather than monocular vision which is the lessor and less serious of these two visual problems. I learned on closing one eye the ghost image disappeared. In the latter case the disorder is called monocular diplopia, which proves to be the less serious of the two visual disorders.
Binocular diplopia may be accompanied with droopy eyelids, eye ache, headache and nausea, none of which I have thankfully. The gamut of causes is very extensive, the severity of symptoms vary from very mild to the other extreme of stroke, brain tumor and at times death from the brain diseases.
In 160 patients with diplopia 70% were males and 30% females. The most common cause in this group was vasculopathy (28.66%) followed by trauma (24.66%) and good news for me elderly patients had more resolution of symptoms than younger patients. Poor prognostic signs are headache, ocular pain, unilateral pupil dilation, muscle weakness, ptosis, trauma or papilledema raise red flags and are said to be occasion for immediate referral. Fortunately I do not have any of those pathological symptoms or conditions. I do have one of the causes, type 2 diabetes, but my diabetes is under excellent control without medication and an A1C of 5.6, which is in the normal range. Many pharmaceuticals, including antidepressant drugs, can cause the diplopia problem but not blood pressure medication which I take.
What should I do about my binocular diplopia?
If I were 40 years old I suspect I would take a doctor’s recommendation to get the cause diagnosed and perhaps treated if possible but at 88 years old, despite my good health, I think I will do nothing and live with it since the system of ghost images itself and not of any great concern. With diplopia the primary care physician is usually the start of the diagnostic endeavor which would be studies by an ophthalmologist, following which there would be two or three more medical specialists including a neurologist and perhaps many diagnostic test procedures such as MRI and others. Do I want to spend much of my remaining time in this world going through such extensive and time consuming medical care? I don’t think I will so I will live with it whether or not it goes away. However, if a physician on the basis of clinical symptoms alone could make a firm diagnosis of an actual serious cause I would entertain a referral.
